Working with Sexual Offenders Assessment, Treatment,

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Working with Sexual OffendersAssessment,
Treatment, Risk Management

• Robin J. Wilson, Ph.D.
• Clinical Director
• The GEO Group, Inc. / Florida Civil Commitment
  Center
• rwilson_at_geocareinc.com

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Defining the Problem

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Victims

• As many as 90 of reporting victims know their
  offender
• 2/3 or more of known offenses occur in the
  victims own home
• As many as 90 of victims fail to report their
  abuse to authorities or others in a position to
  help

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Is Child Sexual Abuse Really That Big a Problem?

• Statistics show that child sexual abuse occurs at
  an alarming rate. As many as one in three girls
  and one in five boys will be sexually abused at
  some point in their childhood (lt18), according to
  many reliable studies of child sexual abuse,
  although most suggest that these are
  underestimates. At a minimum, that means that if
  you attend a social event (like a concert, for
  instance) of 100 people, between 30 and 40 of
  those in attendance were sexually abused as a
  child.

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Consequences for Victims

• Maladaptive sexuality (either hypersexuality or
  hyposexuality)
• Prostitution
• Promiscuity
• Inability to express ones sexuality
• Genital disfigurement
• Sexual addiction
• Eating disorders
• Personality disorders (antisociality, borderline
  features)

• Dissociative disorders
• Suicidality and self-harming behaviours
• Interpersonal problems (e.g., trust, loneliness,
  inability to link with others)
• Loss of relationships with significant others
  (due to the abuse or secondary victimization)
• Substance abuse
• Violence and aggression

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Stakeholders

• victims
• citizens
• law enforcement
• legal and correctional personnel
• mental health personnel
• the media
• offenders

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Sexual Offending

• The past 10-15 years has been witness to a flurry
  of research into the nature and consequences of
  sexually offensive behaviour.
• Isnt it odd that the focus has come so late in
  the game?
• There is no doubt that there has been sexual
  offending since there were people to be offenders
  and others to be victimsthousands and thousands
  of years.
• Why has the attention shifted only recently?

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Official Control

• There are several official means by which to
  control offenders in the community
• Court Diversion
• Probation Parole
• 3 Strikes / Civil Commitment
• Long Term Supervision Orders / Lifetime
  probation
• Court Orders / Orders of Prohibition
• Specialized Peace Bonds
• Electronic/GPS Monitoring
• Sex Offender Registries
• Community Notification
• 1000/2000 feet rules

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Civil CommitmentUSA

• Kansas v. Hendricks (1997)
• Under Kansas' Sexually Violent Predator Act, any
  person who, due to "mental abnormality" or
  "personality disorder", is likely to engage in
  "predatory acts of sexual violence" can be
  indefinitely confined.
• Hendricks appealed, but Supreme Court ultimately
  upheld decision, defining a "mental abnormality"
  as a "congenital or acquired condition affecting
  the emotional or volitional capacity which
  predisposes the person to commit sexually violent
  offenses"
• persons eligible for confinement was limited to
  those not able to control their dangerousness

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Civil CommitmentFlorida

• The Jimmy Ryce Involuntary Civil Commitment for
  Sexually Violent Predators' Treatment and Care
  Act became effective on January 1, 1999.
• Inmates with sexual offense histories are
  reviewed by the Department of Children and
  Families (DCF)
• Court decides who meets criteria for civil
  commitment as an SVP
• Housing and treatment is offered at the Florida
  Civil Commitment Center in Arcadia, FL.

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Offensive Sexual Behavior

• Although we have many laws and practices set up
  to manage risk, in some senses, we may have put
  the cart before the horse.
• One of the greatest hurdles to defining sexual
  deviance is a lack of clarity as to what actually
  constitutes offensive sexual behavior.
• What do you consider to be sexually offensive?

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Assessment

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Why Assess Risk?

• Promoting public safety
• Routine interventions
• Targeting scarce resources
• Officer time
• Treatment
• Exceptional measures

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Dangerousness

• BAD This person is dangerous.
• GOOD If certain risk factors are present, then
  there is a high/medium/low probability that the
  person will engage in a specific type of behavior
  within a specific period of time that may place
  certain persons at risk for a specific type and
  severity of harm.

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Assessment

• assessment forms the foundation upon which all
  subsequent intervention is built
• poor assessment trouble
• comprehensive assessment should take demand
  characteristics into consideration
• assessment is dynamic

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Tenets of Good Assessment

• assess reliability and validity of information
  available
• beware of the base-rate problem
• look for corroboration between different sources
  of information
• beware of malingering and deception--there is
  likely no such thing as a true admitter
• use only standardized measures with documented
  utility for your particular purposes
• avoid speculation unless the evidence is highly
  suggestive

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Assessment

• risk assessment includes consideration of static
  (historical) and dynamic (day-to-day) variables
• risk assessment is facilitated by use of
  actuarial instruments

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STATIC-99 Items

• Scores range 0 to 12
• Prior sex offences (same rules as in RRASOR)
• Prior sentencing dates (excluding index)
• Any convictions for non-contact sex offences
• Index non-sexual violence
• Prior non-sexual violence
• Any unrelated victims
• Any stranger victims
• Any male victims
• Young (aged 18 24.99)
• Single (Ever lived with lover for at least two
  years?)

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Stable Factors

• Significant Social Influences
• Intimacy Deficits
• General Self-Regulation
• Sexual Self-Regulation
• Cooperation with Supervision

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Acute Factors

• Victim Access
• Hostility
• Sexual pre-occupation
• Rejection of Supervision
• Emotional Collapse
• Collapse of Social Supports
• Substance Abuse

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Treatment Intervention

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Nothing Works?

• Martinson (1974)
• Large-scale study of correctional treatment
  outcomes
• Could find no clear evidence that efforts to
  rehabilitate offenders were working
• Led to considerable research into aspects of
  treatment/counseling/interventions that would
  lead to lower recidivism

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Effective Programs

• Based on meta-analytic research, Don Andrews and
  his colleagues have suggested four principles of
  effective correctional interventions.

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Effective Programs

• RISK principle
• effective programs match the level of treatment
  intensity to the level of risk posed by the
  offender
• high risk high intensity
• mismatching can result in increased risk

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Effective Programs

• NEED principle
• effective programs target identified criminogenic
  needs
• sex offenders require sex offender specific
  treatment programming
• other programs may result in some ancillary gain,
  but risk for sexual recidivism likely will not be
  reduced

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Effective Programs

• RESPONSIVITY principle
• effective programs are those which are responsive
  to offender characteristics
• cognitive abilities
• maturity
• motivation
• mode of intervention
• scheduling concerns

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Promising Targets

• changing antisocial attitudes and feelings
• reducing antisocial peer associations
• promoting prosocial associations
• increasing self-control, self-management,
  problem-solving skills
• reducing chemical dependencies
• shifting rewards for behavior from criminal to
  non-criminal orientation
• develop a plan to deal with risky situations
• confront personal barriers to change

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Indicators of Quality Participation

• attendance
• engagement in program
• completion (mature as opposed to premature
  program termination)
• quality relationship with service provider
• respect, positive attitude
• showing change on the intermediate targets

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Stages of Change

• Precontemplation
• no acknowledgement of problems existence
• defensive/unmotivated
• Contemplation
• acknowledgement that problem might exist
• vacillation between minimization and
  acknowledgement
• Preparation
• recognition of the problem
• appearance of motivation
• Action
• active engagement with process of change
• Maintenance
• maintenance of change through application of
  effective coping strategies

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Treatment of Sexual Offenders

• Historically, many types of treatment
  interventions applied to sexual offenders
• Current effective practice requires
• Adherence to principles of risk, need,
  responsivity
• Assessment of risk factors/criminogenic needs
• Cognitive-behavioral intervention
• Treatment that targets identified risk
  factors/criminogenic needs
• Post-treatment maintenance/follow-up programming

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Shortcomings of Relapse Prevention Approach

• Theoretical problems with the model
• Developed using medical model, not
  cognitive-behavioral model
• Designed for use with alcoholic patients who are
  motivated to change
• Developed as maintenance program following
  treatment, not as model of treatment or
  supervision (but has become both in SO treatment)
• Lack of standardization across programs

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Self-Regulation Model (SRM)of Sexual Offending

• Focus is on how people regulate internal and
  external processes as they engage in
  goal-directed actions
• Developed in response to shortcomings identified
  in relapse prevention model
• Acknowledgment that there is more than one
  pathway to offending
• Proposes four pathways to offending based on
  offence-related goals and strategies

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Pathways / Self-Regulation

• avoidant-passive pathway
• an offender following this pathway desires to
  refrain from offending, but does not actively
  attempt to do so, or simply attempts to deny
  urges or to distract himself
• avoidant-active pathway
• offenders following this pathway select
  strategies and make active attempts to achieve
  this inhibitory goal
• approach-automatic pathway
• offenders following this pathway do not attempt
  to refrain from offending, but seek to achieve
  goals associated with offending
• approach-explicit pathway
• The dynamics of offending within this pathway are
  associated with goals which explicitly support
  sexual offending, such as attitudes supporting
  sexual activity with children or hostile
  attitudes toward women

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Good Lives Model (GLM)

• The basic premise of the Good Lives Model is the
  development of a balanced, self-determined
  lifestyle.
• Borrows from self psychology and Life Skills
  model
• Treatment approaches are multi-modal and holistic
• The GLM suggests that successfully-treated
  offenders strive to lead lives that are healthy,
  productive, and free of risk as a natural
  consequence of the stability that comes with
  leading a good life.

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Is Treatment Effective?

• In North America, costs of sexual assault are
  enormous. The cost associated with each sexual
  offender has been estimated as being in excess of
  1.5 million.
• Therefore, a reduction in recidivism of merely
  1, while not likely statistically significant,
  is certainly significant in terms of cost and
  harm reduction.

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California Sex Offender Treatment Evaluation
Project

• The results of the SOTEP study showed no
  differences in sexual reoffending between
  treatment participants, volunteer controls, and
  non-volunteer controls. Follow-up was just over
  eight years and rates of sexual reoffending were
  in the 20 range for all groups.

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Assessment of In-Treatment Change with Sexual
Offenders

• Hanson (1997 2000) suggested that while
  long-term outcome studies are useful, they do not
  tell us anything about the effectiveness of
  current interventions
• Suggested that measuring within-treatment change
  is a more immediate measure of treatment
  effectiveness

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Effective Programs

• The consistency of the outcome studies
  accentuates the need to move beyond simple
  questions as to whether treatment works (Abracen
  Looman, 2004).
• There are a number of significant questions which
  have yet to be answered with reference to sex
  offender treatment.
• For example, do higher risk clients receive more
  treatment programs than lower risk clients?

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Nothing Works?

• One review of studies relating to the
  effectiveness of treatment found that far more
  studies reported positive results (treated group
  with significantly lower recidivist rates than
  untreated) than inconclusive results.
• Another more recent review found that 19 of the
  treated offenders re-offended during an average
  follow-up period of 6.85 years compared with 27
  of the untreated group.

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GEO/FCCCComprehensive Treatment Programming
(CTP) for men who have sexually offended
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GEO/FCCC Treatment Model

• The Comprehensive Treatment Program for men who
  have sexually offended is a multi-phase program.
• Our goal is to integrate best practice models
  from current research and treatment literatures
  into the interventions taking place at the FCCC.
• Programming at FCCC is a comprehensive
  endeavor, and can take up to five years to
  complete.

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GEO/FCCC Treatment Model

• Phase 1 Preparation for Change
• Moral Reconation Therapy
• TRYTreatment Readiness for You
• Thinking for a Change
• Takes up to 18 months to complete.

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GEO/FCCC Treatment Model

• Phase 2 Awareness
• Residents develop an agreed and comprehensive
  identification of the main factors that
  contributed to their past offending
• Disclosure
• Goal is to completely disclose entire history of
  deviant sexuality, with the assistance of
  polygraph
• Discovery
• Goal is to provide opportunities to demonstrate
  insight into the current expression of personal
  risk factors and personal life-barriers
• Depending on the resident, can take 18-24 months.

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GEO/FCCC Treatment Model

• Phase 3 Healthy Alternative Behaviors
• In this phase of Development and Consolidation,
  we encourage residents to re-evaluate
  justifications and attitudes that supported
  offending behavior, leading to increased
  awareness of deficits in emotional coping and/or
  specific problematic emotions, acknowledgement of
  deviant sexual arousal/interest, reduction of
  deviant arousal verbalization of events and
  behaviors the comprised sexual offenses, and the
  application of new coping strategies.
• Depending on the resident, this can also take
  18-24 months.

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GEO/FCCC Treatment Model

• Phase 4 Maintenance and Comprehensive Discharge
  Planning
• This phase of treatment provides additional
  opportunity to evaluate behavioral change and
  skill development, and allows us to gauge to what
  extent each participant has both acquired,
  integrated, and is now demonstrating behaviorally
  the attitudes and skills critical to avoiding
  future sexual offending behavior.
• Residents engage in mock job interviews, make
  connections with social service agencies and
  family/friendly supports, and make preparations
  for life in the community
• Depending on the resident, this can take a year
  or more.

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Challenges at FCCC

• System is slow in determining civil commitment
  or eligibility for release
• Treatment is not available to all offenders
• Detainees are excluded
• Not all offenders want treatment
• No current legislative framework for conditional
  release
• Community is largely unprepared for return of
  offenders to its midst

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RiskManagement

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Todays Situation

• Upon release, many sex offenders are subject to
  public notification, vilification and, sometimes,
  vigilantism.
• As a result, some are eventually driven out of
  one community into another and, often, go
  underground.
• This does not help.

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Risk Management Philosophy

• Sexual offending results from a complex
  interaction of offender specific and
  environmental factors which require competent
  assessment and, ultimately, long-term treatment
  and follow-up.

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Stakeholders

• victims
• citizens
• law enforcement
• legal and correctional personnel
• mental health personnel
• the media
• offenders

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Risk Management

• effective risk management involves the
  collaboration of many different service providers
• Clinical, Correctional, Medical, Law Enforcement,
  Social Service
• varying the mode of contact allows for greater
  monitoring of activities and attitudes
• greater contact and monitoring increases the
  reliability of information leading to case
  management and treatment decisions and initiatives

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Information Sharing

• team work is critical
• offenders must be apprised of the limits of
  confidentiality
• free flow of information is crucial between all
  concerned agencies/parties
• contact with case manager is facilitated by
  regular treatment progress notes and additional
  contact as necessary
• tendency toward secrecy is minimized or
  eliminated
• problems can be quickly identified and managed

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Holes in the System

• However
• SORs and other such measures are often more
  helpful for investigation and prosecution of
  breaches after the fact
• other measures are required to increase client
  accountability and to prevent further
  victimization
• no matter how good your Police Service is,
  officers cannot be held solely responsible for
  the totality of public safety
• community engagement is crucial to ensuring that
  there are no more victims

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Closing Thoughts

• Research has clearly shown that a collaborative
  approach which includes representation from all
  stakeholders can assist considerably in enhancing
  public safety and offender accountability.
  Working together, we can manage the risk.
• Teamwork is the key!!

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Contact Information

• Robin J. Wilson, Ph.D.
• Clinical Director
• The GEO Group, Inc.
• Florida Civil Commitment Center
• 13613 SE Highway 70
• Arcadia, FL 34266
• 941 806 9788
• rwilson_at_geocareinc.com